Bonavia, John P
Bonavia, John P is an individual health care provider with primary practice located at 1317 W Grand Ave , Port Washington WI 53074-2075. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Bonavia, John P can be contacted via phone (262) 268-6998.Contact Information
Primary practice address
1317 W Grand Ave
Port Washington WI 53074-2075
Phone: (262) 268-6998
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 23729 | Wisconsin |
Profile Details
| NPI number | 1497716880 |
|---|---|
| LBN Legal business name | Bonavia, John P |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 28th, 2006 |
| Last updated | Jun 5th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497716880 | NPPES |
| Wisconsin | MEDICAID | 30656000 |
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